Unit Eleven: Health Care Issues

According to the World Health Organization, health is ” a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In previous generations, the focus was on the physical well being of a person. Today, mental health has become a much bigger concern for the medical community. People have suffered from mental ailments through out human history, but only now do these issues make up a part of our health care system. Mental disorders, are patterns of mood, thought or behavior that cause distress and decrease the ability of a person to function.

History of Health Care

In pre-industrial societies, infectious and parasitic diseases posed serious health threats. Diseases were highly contagious and often fatal. Life expectancy in pre-industrial societies was rather short by today’s standards. This was due in part to high rates of infant and childhood mortality. With the emergence of industrial societies came an increase in life expectancy. The increase in life expectancy can be attributed to a decline in infant mortality and changes in people’s lifestyles. Industrialization has made available better diets, improved sanitation, better sewage, and cleaner water. In the past many people died of infectious diseases. Today, more people die from chronic diseases. Chronic diseases, such as heart disease and cancer, progress over a long period of time and often exist long before they are detected.

Social Factors in Health Care

There are a number of social factors that determine the health of individuals. Below is a brief discussion of each.

Socioeconomic Status: Those who are lower on factors such as income, educational achievement, and occupational status generally have higher disease rates and death rates than their more affluent counterparts. The quality of health care in the United States is connected to the ability to pay for it. The incidence of diseases such as cancer, heart disease, and diabetes is higher for lower income groups than for higher income groups. Those in the lower income groups are more likely to live under less sanitary conditions, have less nutritious diets, and work and live in more dangerous environments. Despite access to Medicare and Medicaid, there are still out-of-pocket expenses that the poor can not afford. Finally, those in the lower income groups often receive their treatment in an emergency room instead of a physician’s office.

Race and Ethnicity: Related to social class, race and ethnicity is another source of inequality in health care. Research shows that minorities are at a disadvantage when it comes to health, having higher death rates, shorter life spans, and more serious health conditions. The combination of racial oppression, poverty, and physically demanding jobs works to generate more stress in the lives of minorities. This stress produces greater susceptibility to disease.

Gender: Gender plays a significant role in life expectancy and types of health problems. If we look at how long a person lives, women appear to be healthier than men. Women outlive men by five years. Women also have lower rates of most serious illnesses. How can this be explained? Although males have higher death rates than females at all ages, sociologists believe the higher mortality rates for males are due to traditional sex-role definitions that encourage males to be more aggressive and to seek more stressful and dangerous occupations. Men also make more risky lifestyle decisions such as drinking more alcohol and smoking more tobacco.

International Comparison of Health Care

Health care varies from country to country. In some countries the health systems are run by the private sector, while in others the health system is public, run by the government. How can health care systems be evaluated? The World Health Organization (WHO) came up with a set of five criteria for a “good” and “fair” health systems. They are:

1. Low infant mortality rates and high life expectancy

2. A fair distribution of good health (relatively even mortality and life expectancy rates across the country)

3. A high level of health care responsiveness

4. A fair distribution of responsiveness

5. A fair distribution of financing health care (health care costs are evenly distributed based on a person’s ability to pay).

The WHO found that the United States was first in responsiveness. Responsiveness includes respect for patients as well as prompt attention to their needs. Although the United States was ranked high in one area, it ranked low overall to other wealthy nations. The United States is the only wealthy, industrialized nation that doesn’t provide some form of universal health care.

The United States spends substantially more on health care as a percentage of gross domestic product (GDP) than other developed countries. In 2010, US health care spending amounted to 17.9 percent of GDP, which worked out to $8402 per person.

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. Mental illness refers to any of various psychiatric conditions, usually characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by physiological or psychosocial factors.

Mental health disorders have become increasingly recognized and professionally treated over time. Classifications of specific mental illnesses are relatively new and subject to constant change and adjustment. Over the past few decades more people have sought help for psychological distress. People are more willing to seek help today because attitudes toward mental illness have changed and there is less of a stigma attached to seeking help. Research shows that men and women tend to suffer from different types of mental disorders. Females tend to experience more internalizing problems such as anxiety and/or depression. Males on the other hand tend to externalize problems, leading to aggression, substance abuse, and delinquency. There are different subcategories of mental disorders. Some of the most common are outlined below.

4. Obsessive Compulsive Disorder: People with obsessive compulsive disorder are subjected to recurring thoughts and feelings that cause them extreme distress and anxiety and lead them to carry out certain behaviors. Victims of OCD may find themselves excessively cleaning, counting, or organizing objects to relieve obsessive thoughts.

5. Panic/anxiety disorders. Anxiety disorders arise when normal anxiety is exceeded and it becomes difficult for those afflicted to cope with everyday life. Suffering from intense acute anxiety attacks is known as panic disorder.

6. Eating Disorders: These illnesses are characterized by extreme behavior regarding food, connected to feelings of concern about body image and weight. Some of the eating disorders are anorexia, bulimia, and binge-eating.

7. Attention Deficit Hyperactivity Disorder (ADHD): One of the more common disorders in children, although it is found in adults as well. Symptoms include impulsiveness, hyperactivity, and inattention.

The Problem of Rising Health Care Costs

Throughout the twentieth and into the twenty-first century the cost of health care has risen dramatically. There are a number of factors that account for this increase. First, is the increasing demand for health care services. Whenever there is increased demand for something, it tends to push up prices. Second, the availability of diagnostic and treatment procedures can be quite costly. For example, premature babies who would have died decades ago are now saved in expensive intensive care units. Third, health care is a labor intensive industry. Modern health care requires many trained professionals who require salaries that are commensurate with their training and responsibilities. Improvements in health care often result in the need for more, not fewer workers. Fourth, there is a tendency to over utilize health care services. Physicians and hospitals benefit when more services are provided. This leads to many unnecessary medical procedures. A 2005 National Academy of Sciences report found that 30 percent of U.S. health-care spending was unnecessary or wasteful; more recent studies arrive at similar figures. That amounts to a staggering $600 billion to $700 billion annually. Finally, there are other factors such as rising malpractice premiums and powerful interest groups that make controlling costs difficult.

Many people in the United States do not have easy access to medical care when they need it. Most people rely on health insurance, either purchased by themselves or provided by an employer. The poor and less well-to-do who cannot find jobs that provide health insurance are placed in a difficult situation. That situation has been eased somewhat with the introduction of programs of publicly financed health insurance such as Medicaid, but less than one-half of the poor are eligible for Medicaid. In addition to the poor, there are others who find themselves without health insurance: laid-off employees; people who retire before they are eligible for Medicare; young people who are too old for coverage under their parents’ health insurance plan, and divorced people who had depended on their spouses’ health insurance. A 2012 census report found that 48.6 million Americans were uninsured during 2011. The rate of uninsured ends up being 15.7 percent of the American population.

Another dimension to access to health care is the availability of services. Residents of inner cities and rural areas are underserved. Physicians prefer to practice in areas where they want to live and can make a respectable salary. Inner cities and rural areas tend to not be able to provide for these preferences.

In the past few decades the United States has moved to what is called managed care. Managed care is a health care system that focuses on controlling costs by monitoring and controlling the health care decisions of doctors and patients. Two-thirds of the people who work at medium and large companies in the United States today are enrolled in some form of managed care health system. Part of the managed care system are HMOs or health maintenance organizations. An HMO is an organization that agrees to provide for all of a person’s health care needs for a fixed, periodic premium. The HMO receives a set fee and agrees to take care of all of a person’s health needs for that fee. The HMO assumes a financial risk that the services they give patients might cost more than the premiums the HMO takes in. If this happens the HMO loses money, so the HMO has an incentive to control costs. Whereas most HMOs in the past were not-for-profit organizations, today many HMOs and managed care systems are for-profit organizations. People in managed care systems typically have a limited choice of doctors to choose from, and the managed care system exercises tight control over the medical treatments doctors are allowed to use and the referrals to specialists they are allowed to make. All of this “management” is an effort to control costs.

Criticisms of Private, Managed Health Care

The privatization and corporatization of health care also means that those who cannot afford health care- the poor who do not qualify for Medicaid and those who do not have health insurance on the job- do not have access to the health services they need. Even those with access to a government health plan such as Medicaid, find that they have limited access because the for-profit hospitals and physicians prefer to serve those whose insurance will pay higher fees for services than Medicaid. In addition, expensive medicine, such as emergency medicine, gets dumped onto publicly owned hospitals, which further taxes their ability to provide quality care.

Because the health insurance firms are for-profit entities, they use various techniques to enhance their profits. Raising rates is the most common one. They also hire investigators to examine claims looking for reasons to deny payment. They also employ “rescission” which is a legal term to deny coverageto an insured person because of injury or disease which requires long-term expensive care. Finally, they also do not insure people with a “preexisting condition”. This focus on profits over people has led to the development of the term, “medical-industrial complex“. This term refers to the common interests between physicians, health care providers and industries producing health care goods and services working together to profit from the increased use of these commodities while the health care consumer pays enormous costs for inadequate care.

The national health insurance model views health care as a public good just as fire protection or the public library are. Health care is provided and financed by the government. There are no medical bills for individuals. In some countries, the hospitals are owned by the government, and doctors are government employees. In other governments, health care providers are private, but the payer is the government. There are some in the United States who advocate for a national health care program. They argue that national health insurance would ensure health insurance coverage to the many people who do not currently have any. Another argument is that it would give the government a more direct way of controlling health care costs.

The United States does have two government programs that contain elements of national health care. The first is Medicare. Medicare is a government health insurance program for those over sixty-five years of age. This program pays some of the costs for hospitalization, prescription drugs, nursing home care and some home health care. For a monthly fee the elderly can purchase medical insurance from Medicare that will cover other services such as doctors’ fees and outpatient services.

The other government run health care program is Medicaid. Medicaid is a joint federal-state program to provide medical care for low income people of any age. Each state administers its version of Medicaid with few federal guidelines. Obtaining Medicaid services is a function of the state in which one lives, rather than the level of poverty or need. Millions of poor people in the United States are treated under Medicaid, but there are problems with the program. Many physicians refuse to treat Medicaid patients because the government does not reimburse them enough for their services. or because of delays in getting paid. Another problem is fraud, committed by both recipients and providers of health care. Some physicians provide unneeded treatments and some medical facilities charge for tests never performed. A final problem is the eligibility level of Medicaid in most states is so low that some people who truly need it do not have access to it.

Both Medicare and Medicaid have seen costs increase dramatically over the past few decades. Both federal and state government are looking at ways to control these costs.

On March 23, 2010, President Obama signed the Affordable Care Act into law. The law is also referred to as Obamacare. The law was challenged constitutionally. The Supreme Court ruled in June of 2012 that the new health care law was constitutional. Provisions of the act are set to be put in place over the span of a number of years. There is a mandate that everyone is covered by a health insurance policy or pay a fine. The government will subsidize people with low incomes. Individuals may keep their existing insurance plans. Exchanges will be created on which small businesses and people who buy their own coverage directly from insurers could choose form an array of private plans. If a person is laid off or switches jobs that don’t offer insurance they are still guaranteed coverage. Individuals can not be denied coverage because of a preexisting condition. Young adults will be covered by their parents policy until age 26. Approximately 30 million previously uninsured people will become insured.

There are complaints that Obamacare is a form of socialism. But it is not. If it were the government would provide the health insurance, own the hospitals and hire health professionals as employees. The plan keeps health care as a mostly private system. The plan does not hurt the commercial health insurers. Rather, it brings to the industry 30 million new customers.

Some people argue that the problems of cost, access, and quality of health care are related to the realm of ethics. Bioethics refers to the study of ethical questions that relate to the life and biological well-being of a patient. It involves ethical, medical, and biological considerations. Ethics in medicine goes back a long time. Most people have heard of the Hippocratic Oath which is still held sacred by physicians: to treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation.

A major area where bioethics is concerned is in the prolongation of life. Modern technology can provide medical treatments that can assist the body in staying alive. This means a severely injured, critically ill, or very old person can be kept alive for long periods of time. The ethical question is, should such medical treatment always be used?

The expense of such life-support systems can become a financial burden to the family as well as society at large. From the individual’s perspective there is the loss of dignity that comes from helplessness. Technology has blurred the line between life and death. People can be kept alive even when there is little hope of recovery. This creates an ethical dilemma over who should decide to discontinue life support.

In recent years, debates have swirled over whether or not physicians should be allowed to hasten the death of their incurable patients. Although the Hippocratic Oath forbids medical doctors from prematurely ending the lives of their patients, questions still remain over how physicians should respond to the needs and to the wants of terminally ill individuals. Although the legality and ethics surrounding assisted suicide have been pondered since antiquity, these issues were brought to the forefront in the U.S. during the early 1970s with the arrival of the pro-euthanasia movement. The goal of this movement was to increase the rights of people with terminal illnesses and to give these people more control over their destinies. Since this time, physician-assisted suicide (PAS) is defined as the event wherein a physician provides a competent, terminally ill patient with a prescription of lethal drugs—has become increasingly recognized as a phenomenon deserving of more attention.

Social Problems in Film

Below are a list of movies that exhibit sociological concepts learned in this unit.